|
ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION [38489]
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
NDC 0121067016
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Adventist Health Commercial |
$0.03
|
| Rate for Payer: Blue Shield of California Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.10
|
| Rate for Payer: Cigna of CA PPO |
$0.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Senior |
$0.06
|
| Rate for Payer: Galaxy Health WC |
$0.12
|
| Rate for Payer: Global Benefits Group Commercial |
$0.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$0.11
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.12
|
|
|
ETHOSUXIMIDE 250 MG CAPSULE [9989]
|
Facility
|
IP
|
$0.50
|
|
|
Service Code
|
NDC 6438087806
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Blue Shield of California Commercial |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA PPO |
$0.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
|
|
ETHOSUXIMIDE 250 MG CAPSULE [9989]
|
Facility
|
OP
|
$0.50
|
|
|
Service Code
|
NDC 6438087806
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.35
|
| Rate for Payer: Cigna of CA PPO |
$0.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.43
|
| Rate for Payer: Global Benefits Group Commercial |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.35
|
| Rate for Payer: Multiplan Commercial |
$0.40
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Prime Health Services Commercial |
$0.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.43
|
| Rate for Payer: Vantage Medical Group Senior |
$0.43
|
|
|
ETHYL ALCOHOL 99 % INTRA-ARTERIAL SOLUTION [223863]
|
Facility
|
OP
|
$238.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$202.98 |
| Rate for Payer: Adventist Health Commercial |
$47.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$131.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.10
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cigna of CA HMO |
$167.16
|
| Rate for Payer: Cigna of CA PPO |
$167.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$202.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$202.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.52
|
| Rate for Payer: EPIC Health Plan Senior |
$95.52
|
| Rate for Payer: Galaxy Health WC |
$202.98
|
| Rate for Payer: Global Benefits Group Commercial |
$143.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$167.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$167.16
|
| Rate for Payer: Multiplan Commercial |
$191.04
|
| Rate for Payer: Networks By Design Commercial |
$119.40
|
| Rate for Payer: Prime Health Services Commercial |
$202.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$143.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$143.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.62
|
| Rate for Payer: United Healthcare All Other HMO |
$87.23
|
| Rate for Payer: United Healthcare HMO Rider |
$85.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$202.98
|
| Rate for Payer: Vantage Medical Group Senior |
$202.98
|
|
|
ETHYL ALCOHOL 99 % INTRA-ARTERIAL SOLUTION [223863]
|
Facility
|
IP
|
$238.80
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$202.98 |
| Rate for Payer: Adventist Health Commercial |
$47.76
|
| Rate for Payer: Blue Shield of California Commercial |
$121.07
|
| Rate for Payer: Blue Shield of California Commercial |
$183.64
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cigna of CA HMO |
$167.16
|
| Rate for Payer: Cigna of CA PPO |
$167.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$167.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$95.52
|
| Rate for Payer: EPIC Health Plan Senior |
$95.52
|
| Rate for Payer: Galaxy Health WC |
$202.98
|
| Rate for Payer: Global Benefits Group Commercial |
$143.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$151.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$140.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.31
|
| Rate for Payer: Multiplan Commercial |
$191.04
|
| Rate for Payer: Networks By Design Commercial |
$119.40
|
| Rate for Payer: Prime Health Services Commercial |
$202.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.62
|
| Rate for Payer: United Healthcare All Other HMO |
$87.23
|
| Rate for Payer: United Healthcare HMO Rider |
$85.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.21
|
|
|
ETHYL ALCOHOL (BULK) LIQUID [16626]
|
Facility
|
IP
|
$0.37
|
|
|
Service Code
|
NDC 3877906161
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Blue Shield of California Commercial |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
ETHYL ALCOHOL (BULK) LIQUID [16626]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 3877906161
|
| Hospital Charge Code |
901700001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: Cigna of CA HMO |
$0.24
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.15
|
| Rate for Payer: EPIC Health Plan Senior |
$0.15
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.30
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ETHYL CHLORIDE 100 % TOPICAL SPRAY [2951]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
NDC 9999992951
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
|
|
ETHYL CHLORIDE 100 % TOPICAL SPRAY [2951]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
NDC 9999992951
|
| Hospital Charge Code |
901700016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.23
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO |
$0.23
|
| Rate for Payer: Cigna of CA PPO |
$0.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.14
|
| Rate for Payer: EPIC Health Plan Senior |
$0.14
|
| Rate for Payer: Galaxy Health WC |
$0.31
|
| Rate for Payer: Global Benefits Group Commercial |
$0.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$0.29
|
| Rate for Payer: Networks By Design Commercial |
$0.23
|
| Rate for Payer: Prime Health Services Commercial |
$0.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Vantage Medical Group Senior |
$0.31
|
|
|
ETOMIDATE 20 MG/10 ML INTRAVENOUS SOLUTION - CODE [40820472]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.48
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.58
|
| Rate for Payer: Vantage Medical Group Senior |
$0.58
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
ETOMIDATE 20 MG/10 ML INTRAVENOUS SOLUTION - CODE [40820472]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Adventist Health Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California Commercial |
$0.52
|
| Rate for Payer: Blue Shield of California Commercial |
$0.46
|
| Rate for Payer: Blue Shield of California Commercial |
$0.69
|
| Rate for Payer: Blue Shield of California Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cigna of CA HMO |
$0.63
|
| Rate for Payer: Cigna of CA HMO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.48
|
| Rate for Payer: Cigna of CA PPO |
$0.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.27
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.58
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Global Benefits Group Commercial |
$0.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.45
|
| Rate for Payer: Networks By Design Commercial |
$0.34
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Prime Health Services Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.34
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California Commercial |
$0.24
|
| Rate for Payer: Blue Shield of California Commercial |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.41
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [20472]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.41
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: Cigna of CA HMO |
$0.37
|
| Rate for Payer: Cigna of CA HMO |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.34
|
| Rate for Payer: Cigna of CA HMO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.46
|
| Rate for Payer: Cigna of CA PPO |
$0.38
|
| Rate for Payer: Cigna of CA PPO |
$0.34
|
| Rate for Payer: Cigna of CA PPO |
$0.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.21
|
| Rate for Payer: EPIC Health Plan Senior |
$0.19
|
| Rate for Payer: EPIC Health Plan Senior |
$0.22
|
| Rate for Payer: Galaxy Health WC |
$0.45
|
| Rate for Payer: Galaxy Health WC |
$0.46
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Galaxy Health WC |
$0.41
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.32
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$0.42
|
| Rate for Payer: Networks By Design Commercial |
$0.24
|
| Rate for Payer: Networks By Design Commercial |
$0.33
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.46
|
| Rate for Payer: Prime Health Services Commercial |
$0.41
|
| Rate for Payer: Prime Health Services Commercial |
$0.45
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.24
|
| Rate for Payer: United Healthcare All Other HMO |
$0.18
|
| Rate for Payer: United Healthcare All Other HMO |
$0.20
|
| Rate for Payer: United Healthcare All Other HMO |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.19
|
| Rate for Payer: United Healthcare HMO Rider |
$0.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.46
|
| Rate for Payer: Vantage Medical Group Senior |
$0.45
|
| Rate for Payer: Vantage Medical Group Senior |
$0.41
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.46
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
|
IP
|
$1,530.43
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.09 |
| Max. Negotiated Rate |
$1,300.87 |
| Rate for Payer: Adventist Health Commercial |
$306.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,176.90
|
| Rate for Payer: Blue Shield of California Commercial |
$775.93
|
| Rate for Payer: Cash Price |
$688.69
|
| Rate for Payer: Cigna of CA HMO |
$1,071.30
|
| Rate for Payer: Cigna of CA PPO |
$1,071.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.17
|
| Rate for Payer: EPIC Health Plan Senior |
$612.17
|
| Rate for Payer: Galaxy Health WC |
$1,300.87
|
| Rate for Payer: Global Benefits Group Commercial |
$918.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.30
|
| Rate for Payer: Multiplan Commercial |
$1,224.34
|
| Rate for Payer: Networks By Design Commercial |
$765.22
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.37
|
| Rate for Payer: United Healthcare All Other HMO |
$559.07
|
| Rate for Payer: United Healthcare HMO Rider |
$546.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.22
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [77012]
|
Facility
|
OP
|
$1,530.43
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$306.09 |
| Max. Negotiated Rate |
$7,563.74 |
| Rate for Payer: Adventist Health Commercial |
$306.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,563.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,391.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,387.54
|
| Rate for Payer: Cash Price |
$688.69
|
| Rate for Payer: Cash Price |
$688.69
|
| Rate for Payer: Cigna of CA HMO |
$1,071.30
|
| Rate for Payer: Cigna of CA PPO |
$1,071.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.17
|
| Rate for Payer: EPIC Health Plan Senior |
$612.17
|
| Rate for Payer: Galaxy Health WC |
$1,300.87
|
| Rate for Payer: Global Benefits Group Commercial |
$918.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,142.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,423.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,071.30
|
| Rate for Payer: Multiplan Commercial |
$1,224.34
|
| Rate for Payer: Networks By Design Commercial |
$765.22
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.37
|
| Rate for Payer: United Healthcare All Other HMO |
$559.07
|
| Rate for Payer: United Healthcare HMO Rider |
$546.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.87
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.87
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.99
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1.91
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| Rate for Payer: Vantage Medical Group Senior |
$2.10
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION [10000]
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Adventist Health Commercial |
$0.45
|
| Rate for Payer: Adventist Health Commercial |
$0.49
|
| Rate for Payer: Adventist Health Commercial |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1.73
|
| Rate for Payer: Blue Shield of California Commercial |
$2.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna of CA HMO |
$2.09
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA HMO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$1.57
|
| Rate for Payer: Cigna of CA PPO |
$2.09
|
| Rate for Payer: Cigna of CA PPO |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$0.99
|
| Rate for Payer: EPIC Health Plan Senior |
$0.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.20
|
| Rate for Payer: Galaxy Health WC |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$1.91
|
| Rate for Payer: Galaxy Health WC |
$2.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$2.39
|
| Rate for Payer: Networks By Design Commercial |
$1.24
|
| Rate for Payer: Networks By Design Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.91
|
| Rate for Payer: Prime Health Services Commercial |
$2.10
|
| Rate for Payer: Prime Health Services Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.90
|
| Rate for Payer: United Healthcare HMO Rider |
$0.88
|
| Rate for Payer: United Healthcare HMO Rider |
$1.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.81
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
IP
|
$103.86
|
|
|
Service Code
|
HCPCS J8560
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$88.28 |
| Rate for Payer: Adventist Health Commercial |
$20.77
|
| Rate for Payer: Blue Shield of California Commercial |
$52.66
|
| Rate for Payer: Blue Shield of California Commercial |
$79.87
|
| Rate for Payer: Cash Price |
$46.74
|
| Rate for Payer: Cigna of CA HMO |
$72.70
|
| Rate for Payer: Cigna of CA PPO |
$72.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.54
|
| Rate for Payer: EPIC Health Plan Senior |
$41.54
|
| Rate for Payer: Galaxy Health WC |
$88.28
|
| Rate for Payer: Global Benefits Group Commercial |
$62.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.93
|
| Rate for Payer: Multiplan Commercial |
$83.09
|
| Rate for Payer: Networks By Design Commercial |
$51.93
|
| Rate for Payer: Prime Health Services Commercial |
$88.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.98
|
| Rate for Payer: United Healthcare All Other HMO |
$37.94
|
| Rate for Payer: United Healthcare HMO Rider |
$37.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.01
|
|
|
ETOPOSIDE 50 MG CAPSULE [10001]
|
Facility
|
OP
|
$103.86
|
|
|
Service Code
|
HCPCS J8560
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.77 |
| Max. Negotiated Rate |
$150.58 |
| Rate for Payer: Networks By Design Commercial |
$51.93
|
| Rate for Payer: Adventist Health Commercial |
$20.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.22
|
| Rate for Payer: Blue Shield of California Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$46.74
|
| Rate for Payer: Cash Price |
$46.74
|
| Rate for Payer: Cigna of CA HMO |
$72.70
|
| Rate for Payer: Cigna of CA PPO |
$72.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.30
|
| Rate for Payer: EPIC Health Plan Senior |
$96.87
|
| Rate for Payer: Galaxy Health WC |
$88.28
|
| Rate for Payer: Global Benefits Group Commercial |
$62.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$110.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$118.00
|
| Rate for Payer: Multiplan Commercial |
$83.09
|
| Rate for Payer: Prime Health Services Commercial |
$88.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.98
|
| Rate for Payer: United Healthcare All Other HMO |
$37.94
|
| Rate for Payer: United Healthcare HMO Rider |
$37.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$88.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.87
|
| Rate for Payer: Vantage Medical Group Senior |
$88.06
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 9994080272
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.64
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
ETOPOSIDE ORAL SOLUTION COMPOUND 10 MG/ML [4080272]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 9994080272
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.51
|
| Rate for Payer: Blue Shield of California Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna of CA HMO |
$0.70
|
| Rate for Payer: Cigna of CA PPO |
$0.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
IP
|
$14.98
|
|
|
Service Code
|
NDC 5967657001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11.52
|
| Rate for Payer: Blue Shield of California Commercial |
$7.59
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$11.98
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
|
|
ETRAVIRINE 100 MG TABLET [89432]
|
Facility
|
OP
|
$14.98
|
|
|
Service Code
|
NDC 5967657001
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.61
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cigna of CA HMO |
$10.49
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$12.73
|
| Rate for Payer: Global Benefits Group Commercial |
$8.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$11.98
|
| Rate for Payer: Networks By Design Commercial |
$9.74
|
| Rate for Payer: Prime Health Services Commercial |
$12.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7.49
|
| Rate for Payer: United Healthcare HMO Rider |
$7.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$12.73
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
NDC 5967657101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.23
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cigna of CA HMO |
$20.97
|
| Rate for Payer: Cigna of CA PPO |
$20.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$23.97
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.98
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.47
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
ETRAVIRINE 200 MG TABLET [108431]
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 5967657101
|
| Hospital Charge Code |
901700029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$15.19
|
| Rate for Payer: Blue Shield of California Commercial |
$23.04
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cigna of CA HMO |
$20.97
|
| Rate for Payer: Cigna of CA PPO |
$20.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Multiplan Commercial |
$23.97
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
|
